As of June 1, 2026, Independence Blue Cross (IBX) and Independence Administrators have a new medical policy in place that outlines medical necessity criteria for select elective surgical procedures when requested in the hospital outpatient setting. Certain planned elective procedures may not be appropriate for the hospital outpatient setting but may be suitable for an Ambulatory Surgical Center (ASC) when the anticipated postoperative care needs can be met in that setting. The policy introduces a review for site of care when requested in the outpatient hospital setting for these select services. Please refer to the policy documents for the applicable procedure codes and detailed criteria.
If you intend to perform a procedure listed in Attachment A of the policy in the outpatient hospital setting and not an ASC, you will need an exception request. Exception requests must be submitted via the Practice Management application in the Provider Engagement, Analytics & Reporting (PEAR) portal. Note: Medical necessity justification is required as part of the request.
If you wish to perform the service in an ASC, no action is required.
Submitting exception requests
When submitting an exception request in PEAR, you may see a message for certain self-funded members advising that no precertification is required in the outpatient hospital setting. Despite this message, an authorization request must still be submitted for all members when performing a procedure listed in Attachment A of the policy in the outpatient hospital setting to ensure accurate processing.
We are committed to ensuring members receive care that aligns with medical policy criteria and is delivered in clinically appropriate, safe, and cost-effective settings. Site of care reviews are key to this process.
Learn more
Review the following policies, effective June 1, 2026:
To access the most updated version of any active policy, please refer to the Medical and Claim Payment Policy Portal or simply navigate to the Commercial or Medicare Advantage policy bulletins.
26-0040